Provider Demographics
NPI:1972654119
Name:WHITING, GEOFFREY C (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:C
Last Name:WHITING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4370
Mailing Address - Country:US
Mailing Address - Phone:607-329-0681
Mailing Address - Fax:
Practice Address - Street 1:403 E BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4370
Practice Address - Country:US
Practice Address - Phone:607-329-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144755-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110079988AMedicaid
MA110079988AMedicaid
B81797Medicare UPIN